Comparison of sevoflurane and nitrous oxide mixture with nitrous oxide alone for inhalation conscious sedation in children having dental treatment: a randomised controlled trial

Abstract

SummaryWe studied 411 children aged 3-10 years who were referred for dental treatment. They were randomly allocated to have inhalation conscious sedation with either sevoflurane ⁄ nitrous oxide mixture or nitrous oxide alone. Dental treatment was satisfactorily completed in 215 ⁄ 241 children who were given sevoflurane ⁄ nitrous oxide mixture (89%) compared with 89 ⁄ 170 who were given nitrous oxide alone (52%) (Chi square 70.3, p < 0.0001). All children remained conscious and responsive to verbal contact throughout the treatment and in the recovery room. No adverse side-effects were recorded in either group and there were no significant differences in oxygen saturation, heart rate, recovery profile, or time to discharge home between the groups. The study concluded that, for every 100 children treated with sevoflurane ⁄ nitrous oxide mixture, 37 children would be saved a general anaesthetic if given combined sevoflurane and nitrous oxide mixture rather than nitrous oxide alone. The use of sevoflurane in low concentrations 0.1-0.3% to supplement nitrous oxide and oxygen for inhalation conscious sedation is safe, practical, and significantly more effective than nitrous oxide alone in children having dental treatment.

Conscious sedation for children

“…Next, we conducted a randomised controlled clinical trial to compare this mixture with nitrous oxide alone for inhalation conscious sedation. The results showed that the technique was effective in 89% (215 ⁄ 241 children) in the sevoflurane ⁄ nitrous oxide group compared with 52% (89 ⁄ 170 children) in the nitrous oxide only group [3]. No adverse side-effects were recorded in either group.…”

“…Our analysis of responses to abnormal monitor readings and alarms (including some silencing of alarms and why this might occur) has already been published [2] and we have made some suggestions for training in this area [3]. However, with reference to what Beatty and Beatty term violations, we observed 21 instances of what might be termed 'variances from usual process' (even the choice of name has to be made carefully to avoid normative overtones).…”

“…The driving force for our developments, and we suspect also for the study by Averley and colleagues, is concern about the safety of sedation with intravenous midazolam. We are not convinced of the complete safety of intravenous midazolam, even when given incrementally, and there have been a number of studies questioning its safety particularly during endoscopic procedures [1][2][3][4]. As well as dental patients, our system has been successfully used during endoscopic procedures [5].…”

Efficacy of Inhaled Sevoflurane Sedation Compared with Nitrous Oxide in Managing Children Undertaking Dental Extraction: A Randomized Controlled Trial

“…Although Nitrous oxide inhalation sedation (N 2 O IHS) is commonly used in dentistry practice and it has impressive safety and is excellent for providing conscious sedation for apprehensive dental patients [9], it is not successful in all cases [8,[10][11][12]. So a considerable amount of research has been carried out into other sedation techniques acceptable to those patients who are not suitable or who fail to cope with nitrous oxide sedation [13]. One alternative conscious sedation technique that has been reported is the use of the gas sevoflurane (sevo) as an IHS agent [13][14][15][16].…”

“…So a considerable amount of research has been carried out into other sedation techniques acceptable to those patients who are not suitable or who fail to cope with nitrous oxide sedation [13]. One alternative conscious sedation technique that has been reported is the use of the gas sevoflurane (sevo) as an IHS agent [13][14][15][16].…”